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M1311 Comorbidities and Resource use by Persons With and Without Irritable Bowel Syndrome (IBS) in a Large Managed Care Population
limbic regions in the anticipation phase and movement-related areas during esophageal pain. In contrast, females, showed greater activation in movement-related areas during the anticipation phase and limbic regions during esophageal pain. These differences may reflect differences in emotional procession of visceral noxious information in men and women.
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M1311
Virtual Visual Stress Enhances Gastric Hypersensitivity in Functional Dyspepsia Tomotaka Shoji, Joe Morishita, Yuka Endo, Yasuhiro Sagami, Takatsugu Machida, Tomomi Machida, Motoyori Kanazawa, Shin Fukudo, Michio Hongo
Comorbidities and Resource use by Persons With and Without Irritable Bowel Syndrome (IBS) in a Large Managed Care Population Uri Ladabaum, Annie Sharabidze, Wei K. Zhao, Elaine H. Chung, Theodore R. Levin BACKGROUND: Persons with IBS may experience comorbidities, including psychiatric disorders, and use medical resources at higher rates than persons without IBS. AIMS: To compare comorbidities and resource use in persons with IBS and those without IBS in a diverse population-based cohort from a large health maintenance organization (HMO). METHODS: Northern California Kaiser Permanente databases were searched to identify all members diagnosed with IBS. Controls were matched by age, sex, and period of enrollment. RESULTS: From 1995-2005, 2.4-3.2 million persons (51% female) belonged to the HMO. IBS was diagnosed in 141,295 (age mean 46, SD 17; 74% female). 141,294 age, sex and enrollment-matched controls were identified. IBS patients were substantially more likely to have other pain syndromes (migraine 37 vs. 20%, fibromyalgia 6 vs. 1%, chronic pain syndrome 18 vs. 8%, p<0.0001) and psychiatric comorbidity (anxiety 36 vs. 15%, depression 39 vs. 20%, p<0.0001). Testing for celiac disease was rare (2.7 vs. 0.3%, p<0.0001) and few patients ultimately received a diagnosis of celiac disease (0.1 vs. 0.02%, p<0.0001). Few patients went on to receive other gastrointestinal diagnoses (Crohn's 0.7 vs. 0.2%, colitis 1.9 vs. 0.6%, p<0.0001). IBS patients were more likely to have had common laboratory tests (CBC 95 vs. 82%, ESR 48 vs. 27%, chemistries 88 vs. 72%, LFTs 87 vs. 67%, thyroid 88 vs. 71%, p<0.0001). IBS patients were substantially more likely to have undergone endoscopic (sigmoidoscopy 42 vs. 22%, colonoscopy 14 vs. 6%, EGD 14 vs. 5%, ERCP 0.5 vs. 0.2%, p<0.0001) and radiographic tests (X-ray 21 vs. 9%, barium enema 17 vs. 4%, CT 23 vs. 10%, US 35 vs. 16%, upper GI 13 vs. 4%, all p<0.0001). Use of alosetron (0.09%) and tegaserod (0.5%) in IBS patients was rare. IBS patients were substantially more likely to have psychiatric medications (anxiolytics 44 vs. 27%, antidepressants 55 vs. 29%, p<0.0001). IBS patients were more likely to have abdominal and pelvic operations (intestinal 5 vs. 3%, abdominal 2 vs. 1%, biliary 6 vs. 3%, gynecologic 9 vs. 6%, p<0.0001). CONCLUSIONS: In this large study, IBS patients had consistently higher rates than controls of chronic pain syndromes and psychiatric comorbidities, common and GI-specific tests, psychiatric medication use, and abdominal and pelvic operations. Celiac antibody testing, which has been advocated by some only recently in IBS, was uncommon. Other GI diagnoses were rare. This large study details a consistent pattern of greater morbidity and resource use by IBS patients compared to controls, and provides quantitative estimates of the impact in a large managed care cohort.
[Background] Psychological stress is one of the strong triggers that induce gastric symptoms in functional dyspepsia. Previously we reported that in healthy subjects virtual stress induced increase of gastric volume and gastric hypersensitivity, which relate to the pathophysiology of functional dyspepsia. [Aim] We tested our hypothesis that psychological stress can induce excessive changes of gastric volume and sensation in functional dyspepsia than in healthy subjects. [Subjects & Methods] Nine functional dyspepsia non-consulters (FD) and 9 healthy subjects (HS) were recruited in this study. Virtual visual stress (VS) was loaded with a 3D roller coaster movie for 10 minutes by the head-mounted display. Gastric volume and compliance were measured by barostat technique during the virtual stress session. At the beginning and end of the VS session, gastric perception was evaluated by barostat bag distention, then 3 perception thresholds were defined (first sensation (F), discomfort (D), and pain (P)). Subjective gastric perception and stress sensation during the stress were evaluated on the gastric symptom questionnaires consisted of 7 graded ordinate scales. [Results] During VS, FD reported higher stress sensation than in HC (p=0.0163, ANOVA). VS induced gastric volume increase both in FD and in HS (p=0.001). However, the changes of gastric volume in FD were not different in HS (p=0.88, ANOVA). Basal gastric perceptional thresholds were significantly lower in FD than in HS (p<0.001). After VS session, gastric perceptional thresholds significantly decreased in both FD and HS (p<0.001 ANOVA, vs. basal thresholds). Nausea symptom was moderate but remarkably induced in FD during VS compared with HS. [Summary] Virtual stress remarkably reduced gastric perceptional thresholds in functional dyspepsia, which suggested that psychological stress induce gastric symptoms by enhancing gastric hypersensitivity. Effects of VS on gastric volume and perception in FD and HS
M1313 Association of the 5HT-2a Receptor Gene -1438g/a Polymorphism in Patients With Functional Dyspepsia Fumihiko Toyoshima, Tadayuki Oshima, Shigemi Nakajima, Takahisa Yamasaki, Toshihiko Tomita, Yongmin Kim, Jiro Watari, Takayuki Matsumoto, Hiroto Miwa Background and Aims: Although, familial clustering of functional dyspepsia (FD) has been reported, the role of genotype in susceptibility to functional dyspepsia (FD) is still not well established. Associations between irritable bowel syndrome (IBS) and 5HT2A receptor gene polymorphism have now been reported. However, there is no equivalent report linking FD and 5HT-2A receptor gene polymorphisms. Here, we determined the association between the 5HT2A receptor gene -1438G/A polymorphism and FD patients in the Japanese population. Methods: Seventy three patients seen at Hyogo College Hospital showing an FD diagnosis (by ROME III criteria) and 146 age and gender matched subjects seen at Shiga Hospital for their health check up without abdominal symptoms were enrolled in this study. This study was approved by the ethical committee of the institutes. Subjects with FD were divided in groups of postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) of the Rome III from their symptoms. The 5HT-2A receptor gene -1438G/A polymorphism was determined by polymerase chain reaction plus digestion. Odds ratio for dyspepsia phenotype relative to their genotype were calculated using logistic regression analysis. Results: The 5HT-2A receptor gene -1438G/A polymorphism in without dyspepsia (control) and FD patients did not deviate significantly from those expected under the Hardy-Weinberg equilibrium. The 5HT-2A genotype distribution in subjects with control was 42 GG (28.8%), 79 GA (54.1%), and 25 AA (17.1%), whereas the distribution in subjects with FD patients was 11 GG (15.1%), 28 GA (38.4%), and 34 AA (46.6%). Homozygous 5HT2A -1438A allele was significantly associated with risk of FD after logistic regression analysis (17.1% vs. 46.6%; GA/GG vs. AA; OR = 4.73, 95% CI: 2.44-9.16). Furthermore, there was a significant correlation between homozygous 5HT-2A -1428A allele and EPS in patients (17.6% vs. 49.0%; GA/GG vs. AA; OR = 4.80, 95% CI:2.21-10.39) and PDS patients (14.2% vs. 47.2%; GA/GG vs. AA; OR = 6.33, 95% CI:2.79-14.33). Conclusions: 5HT-2A -1483A allele homozygosity increases the susceptibility to FD.
VS: virtual stress stimulation, FD: functional dyspepsia, HS: healty subject M1310 Gender Differences in Brain Activity Evoked by Visceral Pain in Healthy Subjects Michiko Kano, Steven J. Coen, Adam D. Farmer, Shin Fukudo, Qasim Aziz INTRODUCTION: Gender differences in the experience of pain have been described. Females display greater pain sensitivity and are more likely than males to suffer from many chronic pain conditions, including functional gastrointestinal disorders. However due to the limited number of studies performed to date, information available about gender-differences in normal human central processing of visceral pain is still preliminary. We investigated whether gender differences exist in brain response to esophageal pain in a large cohort of healthy volunteers. METHODS: Sixteen males and sixteen females participated in the study. Functional magnetic resonance imaging (fMRI) was used to acquire blood oxygen level dependant contrast images at 3 Tesla. Data was collected whilst subjects received painful balloon distensions to the distal as well as during anticipation of pain. Pain stimulation was titrated to the level of pain threshold in each volunteer. During fMRI scanning, subjective perception of the pain stimulus was measured by visual analog scale (VAS) from 0 (no sensation) to 100 (maximal pain). The Eysenck Personality Questionnaire-Revised (EPQ-R) was used to assess personality trait in each subject. RESULTS: The averaged neuroticism score of male subjects was 8.6 ± 6.7 (mean ± SD) and the score of females was 7.4 ± 5.9 (p>0.05). During fMRI scanning, mean VAS score of males was 61.6 ± 12.2 and the score of females was 63.7 ± 10.5 (p>0.05). During anticipation, males demonstrated greater activation in comparison to females in the mid-cingulate gyrus and the right amygdale, whilst females produced greater brain activity than males in the right supplementary motor area (SMA) and cerebellum (p < 0.05, corrected). Duuring esophageal pain males showed greater activation in the right SMA and left caudate than females, whilst females showed greater activation in the midcingulate gyrus and cerebellum (p < 0.05, corrected). CONCLUSIONS: The present study demonstrates gender differences in the brain processing of the esophageal pain experience despite similar personality and pain perception. Males demonstrated greater activation in
M1314 Overlap of Dyspepsia and Gastroesophageal Reflux in the General Population: One Disease or Distinct Entities? A Population-Based Study Rok Seon Choung, G. Richard Locke, Cathy Schleck, Alan R. Zinsmeister, Nick Talley Background: Both functional dyspepsia (FD) and gastroesophageal reflux disease (GER) are extremely common disorders of the gastrointestinal tract; individually they cause chronic or recurrent upper gastrointestinal symptoms. The overlap of GER with FD is known to be frequent but whether the overlap group is a distinct entity or not remains unclear, as is the magnitude of the overlap in the community. Furthermore, risk factors that may account for the overlap between dyspepsia and reflux symptoms have not been defined. Aim: To
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AGA Abstracts
AGA Abstracts
neural effects of VNS in BOLD signals, activations following ephedrine iv were obtained in regions that could be only partly superimposed on VNS activations. It is thus likely that 5Hz VNS induces central activations in addition to peripheral actions. 1.Bernik TR et al. J Exp Med 2002;195:781-8. 2.Meregnani J et al. Gastroenterology 2009;136:W1706.
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M1311
Virtual Visual Stress Enhances Gastric Hypersensitivity in Functional Dyspepsia Tomotaka Shoji, Joe Morishita, Yuka Endo, Yasuhiro Sagami, Takatsugu Machida, Tomomi Machida, Motoyori Kanazawa, Shin Fukudo, Michio Hongo
Comorbidities and Resource use by Persons With and Without Irritable Bowel Syndrome (IBS) in a Large Managed Care Population Uri Ladabaum, Annie Sharabidze, Wei K. Zhao, Elaine H. Chung, Theodore R. Levin BACKGROUND: Persons with IBS may experience comorbidities, including psychiatric disorders, and use medical resources at higher rates than persons without IBS. AIMS: To compare comorbidities and resource use in persons with IBS and those without IBS in a diverse population-based cohort from a large health maintenance organization (HMO). METHODS: Northern California Kaiser Permanente databases were searched to identify all members diagnosed with IBS. Controls were matched by age, sex, and period of enrollment. RESULTS: From 1995-2005, 2.4-3.2 million persons (51% female) belonged to the HMO. IBS was diagnosed in 141,295 (age mean 46, SD 17; 74% female). 141,294 age, sex and enrollment-matched controls were identified. IBS patients were substantially more likely to have other pain syndromes (migraine 37 vs. 20%, fibromyalgia 6 vs. 1%, chronic pain syndrome 18 vs. 8%, p<0.0001) and psychiatric comorbidity (anxiety 36 vs. 15%, depression 39 vs. 20%, p<0.0001). Testing for celiac disease was rare (2.7 vs. 0.3%, p<0.0001) and few patients ultimately received a diagnosis of celiac disease (0.1 vs. 0.02%, p<0.0001). Few patients went on to receive other gastrointestinal diagnoses (Crohn's 0.7 vs. 0.2%, colitis 1.9 vs. 0.6%, p<0.0001). IBS patients were more likely to have had common laboratory tests (CBC 95 vs. 82%, ESR 48 vs. 27%, chemistries 88 vs. 72%, LFTs 87 vs. 67%, thyroid 88 vs. 71%, p<0.0001). IBS patients were substantially more likely to have undergone endoscopic (sigmoidoscopy 42 vs. 22%, colonoscopy 14 vs. 6%, EGD 14 vs. 5%, ERCP 0.5 vs. 0.2%, p<0.0001) and radiographic tests (X-ray 21 vs. 9%, barium enema 17 vs. 4%, CT 23 vs. 10%, US 35 vs. 16%, upper GI 13 vs. 4%, all p<0.0001). Use of alosetron (0.09%) and tegaserod (0.5%) in IBS patients was rare. IBS patients were substantially more likely to have psychiatric medications (anxiolytics 44 vs. 27%, antidepressants 55 vs. 29%, p<0.0001). IBS patients were more likely to have abdominal and pelvic operations (intestinal 5 vs. 3%, abdominal 2 vs. 1%, biliary 6 vs. 3%, gynecologic 9 vs. 6%, p<0.0001). CONCLUSIONS: In this large study, IBS patients had consistently higher rates than controls of chronic pain syndromes and psychiatric comorbidities, common and GI-specific tests, psychiatric medication use, and abdominal and pelvic operations. Celiac antibody testing, which has been advocated by some only recently in IBS, was uncommon. Other GI diagnoses were rare. This large study details a consistent pattern of greater morbidity and resource use by IBS patients compared to controls, and provides quantitative estimates of the impact in a large managed care cohort.
[Background] Psychological stress is one of the strong triggers that induce gastric symptoms in functional dyspepsia. Previously we reported that in healthy subjects virtual stress induced increase of gastric volume and gastric hypersensitivity, which relate to the pathophysiology of functional dyspepsia. [Aim] We tested our hypothesis that psychological stress can induce excessive changes of gastric volume and sensation in functional dyspepsia than in healthy subjects. [Subjects & Methods] Nine functional dyspepsia non-consulters (FD) and 9 healthy subjects (HS) were recruited in this study. Virtual visual stress (VS) was loaded with a 3D roller coaster movie for 10 minutes by the head-mounted display. Gastric volume and compliance were measured by barostat technique during the virtual stress session. At the beginning and end of the VS session, gastric perception was evaluated by barostat bag distention, then 3 perception thresholds were defined (first sensation (F), discomfort (D), and pain (P)). Subjective gastric perception and stress sensation during the stress were evaluated on the gastric symptom questionnaires consisted of 7 graded ordinate scales. [Results] During VS, FD reported higher stress sensation than in HC (p=0.0163, ANOVA). VS induced gastric volume increase both in FD and in HS (p=0.001). However, the changes of gastric volume in FD were not different in HS (p=0.88, ANOVA). Basal gastric perceptional thresholds were significantly lower in FD than in HS (p<0.001). After VS session, gastric perceptional thresholds significantly decreased in both FD and HS (p<0.001 ANOVA, vs. basal thresholds). Nausea symptom was moderate but remarkably induced in FD during VS compared with HS. [Summary] Virtual stress remarkably reduced gastric perceptional thresholds in functional dyspepsia, which suggested that psychological stress induce gastric symptoms by enhancing gastric hypersensitivity. Effects of VS on gastric volume and perception in FD and HS
M1313 Association of the 5HT-2a Receptor Gene -1438g/a Polymorphism in Patients With Functional Dyspepsia Fumihiko Toyoshima, Tadayuki Oshima, Shigemi Nakajima, Takahisa Yamasaki, Toshihiko Tomita, Yongmin Kim, Jiro Watari, Takayuki Matsumoto, Hiroto Miwa Background and Aims: Although, familial clustering of functional dyspepsia (FD) has been reported, the role of genotype in susceptibility to functional dyspepsia (FD) is still not well established. Associations between irritable bowel syndrome (IBS) and 5HT2A receptor gene polymorphism have now been reported. However, there is no equivalent report linking FD and 5HT-2A receptor gene polymorphisms. Here, we determined the association between the 5HT2A receptor gene -1438G/A polymorphism and FD patients in the Japanese population. Methods: Seventy three patients seen at Hyogo College Hospital showing an FD diagnosis (by ROME III criteria) and 146 age and gender matched subjects seen at Shiga Hospital for their health check up without abdominal symptoms were enrolled in this study. This study was approved by the ethical committee of the institutes. Subjects with FD were divided in groups of postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) of the Rome III from their symptoms. The 5HT-2A receptor gene -1438G/A polymorphism was determined by polymerase chain reaction plus digestion. Odds ratio for dyspepsia phenotype relative to their genotype were calculated using logistic regression analysis. Results: The 5HT-2A receptor gene -1438G/A polymorphism in without dyspepsia (control) and FD patients did not deviate significantly from those expected under the Hardy-Weinberg equilibrium. The 5HT-2A genotype distribution in subjects with control was 42 GG (28.8%), 79 GA (54.1%), and 25 AA (17.1%), whereas the distribution in subjects with FD patients was 11 GG (15.1%), 28 GA (38.4%), and 34 AA (46.6%). Homozygous 5HT2A -1438A allele was significantly associated with risk of FD after logistic regression analysis (17.1% vs. 46.6%; GA/GG vs. AA; OR = 4.73, 95% CI: 2.44-9.16). Furthermore, there was a significant correlation between homozygous 5HT-2A -1428A allele and EPS in patients (17.6% vs. 49.0%; GA/GG vs. AA; OR = 4.80, 95% CI:2.21-10.39) and PDS patients (14.2% vs. 47.2%; GA/GG vs. AA; OR = 6.33, 95% CI:2.79-14.33). Conclusions: 5HT-2A -1483A allele homozygosity increases the susceptibility to FD.
VS: virtual stress stimulation, FD: functional dyspepsia, HS: healty subject M1310 Gender Differences in Brain Activity Evoked by Visceral Pain in Healthy Subjects Michiko Kano, Steven J. Coen, Adam D. Farmer, Shin Fukudo, Qasim Aziz INTRODUCTION: Gender differences in the experience of pain have been described. Females display greater pain sensitivity and are more likely than males to suffer from many chronic pain conditions, including functional gastrointestinal disorders. However due to the limited number of studies performed to date, information available about gender-differences in normal human central processing of visceral pain is still preliminary. We investigated whether gender differences exist in brain response to esophageal pain in a large cohort of healthy volunteers. METHODS: Sixteen males and sixteen females participated in the study. Functional magnetic resonance imaging (fMRI) was used to acquire blood oxygen level dependant contrast images at 3 Tesla. Data was collected whilst subjects received painful balloon distensions to the distal as well as during anticipation of pain. Pain stimulation was titrated to the level of pain threshold in each volunteer. During fMRI scanning, subjective perception of the pain stimulus was measured by visual analog scale (VAS) from 0 (no sensation) to 100 (maximal pain). The Eysenck Personality Questionnaire-Revised (EPQ-R) was used to assess personality trait in each subject. RESULTS: The averaged neuroticism score of male subjects was 8.6 ± 6.7 (mean ± SD) and the score of females was 7.4 ± 5.9 (p>0.05). During fMRI scanning, mean VAS score of males was 61.6 ± 12.2 and the score of females was 63.7 ± 10.5 (p>0.05). During anticipation, males demonstrated greater activation in comparison to females in the mid-cingulate gyrus and the right amygdale, whilst females produced greater brain activity than males in the right supplementary motor area (SMA) and cerebellum (p < 0.05, corrected). Duuring esophageal pain males showed greater activation in the right SMA and left caudate than females, whilst females showed greater activation in the midcingulate gyrus and cerebellum (p < 0.05, corrected). CONCLUSIONS: The present study demonstrates gender differences in the brain processing of the esophageal pain experience despite similar personality and pain perception. Males demonstrated greater activation in
M1314 Overlap of Dyspepsia and Gastroesophageal Reflux in the General Population: One Disease or Distinct Entities? A Population-Based Study Rok Seon Choung, G. Richard Locke, Cathy Schleck, Alan R. Zinsmeister, Nick Talley Background: Both functional dyspepsia (FD) and gastroesophageal reflux disease (GER) are extremely common disorders of the gastrointestinal tract; individually they cause chronic or recurrent upper gastrointestinal symptoms. The overlap of GER with FD is known to be frequent but whether the overlap group is a distinct entity or not remains unclear, as is the magnitude of the overlap in the community. Furthermore, risk factors that may account for the overlap between dyspepsia and reflux symptoms have not been defined. Aim: To
S-377
AGA Abstracts
AGA Abstracts
neural effects of VNS in BOLD signals, activations following ephedrine iv were obtained in regions that could be only partly superimposed on VNS activations. It is thus likely that 5Hz VNS induces central activations in addition to peripheral actions. 1.Bernik TR et al. J Exp Med 2002;195:781-8. 2.Meregnani J et al. Gastroenterology 2009;136:W1706.